Headaches Flashcards
First line treatments for tension headaches include _____ and _____. They should be taken no more than ______ a week
ASA
APAP
2 days a week
Second line treatments for TTH (tension type headaches) include _______.
Aleve
Advil
If a second line treatment for headache, such as Aleve or Advil, fails after ______ consecutive headaches, then____
two another agent of this class should be tried
If second line treatments for TTH provide incomplete relief, ____ may help
antiemetics
Another effective second line treatment for TTH that can be bought over the counter is _____ which contains ____
Excedrin Extra Strength
Caffeine
Third line therapy for TTH, ______ containing agents, such as ______. These should be used no more than_____
Butalbital
Fioricent (Fiorinal)
3 times a month
If a patient has more that ____ TTH per week, or severe TTH can be given prophylactic ____
two
antidepressants
Three antidepressants used for prevention of severe or persistent TTH are
Amitriptyline (Elavil)
Venlafaxine XR (Effexor)
Mirtazapine (Remeron)
a major adverse effect of antidepressant use is
increased suicide risk in young adults (18-24), adolescents and children
Amitriptyline (Elavil)
TCA
depression, migraine prophylaxis, eating disorder
serotonin and norepinephrine reuptake inhibitor, anticholinergic
suicide risk
take before bed to reduce daytime sleepiness, may take up to 4 weeks to see full effect
Venlafaxine (Effexor)
antidepressant, SNRI
depression, generalized anxiety, headache prophylaxis
**suicide risk in children, adolescents and young adults
**do not administer with monoamine oxidase inhibitors (MAOI)
**angle closure glaucoma risk
Mirtazapine (Remeron)
antidepressant
**reduced renal and hepatic clearance
adverse effects: somnolence, weight gain, xerostomia
**suicide risk
First line treatments for migraine headaches include ____ and ____. OTC medicines including____ such as ____ are also effective
NSAIDs and ASA
caffeine
Excedrin
Second line treatment for migraine type headaches are the ___
Triptans (Serotonin 5-HT1 agonists)
The pathophysiology of headaches is thought to be ____, therefore triptans, a migraine specific drug, work by ____, and are contraindicated in
vasodilation
vasoconstriction
pregnancy, ischemic heart disease, CAD, uncontrolled HTN
within 24 hrs of ergotamine containing medications
within 2 weeks of MAOI
serotonin syndrome risk
**Renal and hepatic adjustment
Seven examples of Triptans (5 HT1 agonists) are \_\_ \_\_ \_\_ \_\_ \_\_ \_\_ \_\_
Sumatriptan (Imitrex) Zolmitriptan (Zomig) Naratriptan (Amerge) Rizatriptan (Maxalt) Almotriptan (Axert) Eletriptan (Relpax) Frovatriptan (Frova)
Although less safe than the second line treatment for migraines, the ____, the drug class ______ is the third line treatment for migraine headaches.
triptans
ergot derivatives
Ergotamine warnings
may cause ischemia to hands, feet and brain
contraindicated in CAD and PVD
may cause severe nausea and vomiting
If migraine specific medications have failed, ____ can be used
Butalbital containing agents (Fioricet, Fiorinal)
Two classes of drugs that can be used as rescue medications for migraine headache include ___ and ___
Opioids and steroids
An example of a steroid for a severe, persistent migraine refractory to abortive treatment is ___
a five-day course of 6mg of dexamethasone, until the pt headache free for 24 hrs
Abortive agents for headache may be augmented by ____
anti-emetics
Three examples of antiemetic agents are ___, ___ and ___
Prochlorperazine (Compazine) –comes in suppository form
Metoclopramide (Reglan)
Droperidol (Qt prolongation, Torsade de pointes)
Two major side effects of Droperidol are ___ and ___
QT prolongation and Torsade de pointes
Several prophylactic medications for migraine headaches come from these drug classes: ________________________________
Beta-blockers TCA Anticonvulsants MAOIs Calcium channel blockers Gabapentin SSRIs
Examples of betablockers for the prevention of migraine headaches are
Propranolol
Timolol
Examples of Tricyclic antidepressants for prevention of migraine headache are
Amitriptyline (Elavil)
Imipramine (Tofranil)
Nortriptyline (Pamelor)
Examples of anticonvulsants used for migraine prophylaxis are
Depakote -hepatic dosing
Topiramate -renal dosing
Patients experiencing cluster headaches should be___
immediately referred to neuro to exclude potentially serious differential diagnoses
Cluster headaches can be treated with _________, and prevented by_____
SQ Sumatriptan, intranasal Sumatriptan, Zolmitriptan nasal spray, and 15-30min/daily 100% nonrebreather oxygen
SQ octreotide, olanzapine, intranasal lidocaine
Verapamil, Lithium, Topiramate, Gabapentin, valproic acid, leuprolide, intranasal capsaicin, and baclofen
